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Patient Camcorder No. Date MeasuredTelephoneMeasured byEmailClinic / HospitalPlease enter the quantity required in appropriate box. PIP codes shown in red. Clinic codes shown in blue. FOOT
REGULARLY
LONGREGULARTHIGH
TALLSHORTREGULARTALLESFL1
4005419ESLR1
4005518ESLT1
4005567ESTS1
4005666ESTR1
4005617ESTT1
4005716SESFR2
4005476ESFL2
4005427ESLR2
4005526ESLT2
4005575ESTS2
4005674ESTR2
4005625ESTT2
4005724MESFR3
4005484ESFL3
4005435ESLR3
4005534
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Step 1: Gather all necessary documents such as identification card, insurance information, and medical history.
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What is clinic hospital?
A clinic hospital is a healthcare facility that provides medical services to patients.
Who is required to file clinic hospital?
Clinic hospitals are required to file by healthcare providers who operate such facilities.
How to fill out clinic hospital?
Clinic hospitals can be filled out online or submitted through the appropriate healthcare regulatory body.
What is the purpose of clinic hospital?
The purpose of clinic hospitals is to provide medical care and treatment to patients in need.
What information must be reported on clinic hospital?
Clinic hospitals must report information such as patient demographics, medical services provided, and billing details.
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